Intraocular telescope

ABSTRACT

The present invention relates to an intraocular lens, including a first lens having a first portion configured to alter light rays passing therethrough in a first manner and form a first image in an eye and a second portion adjacent said first portion. A second lens is coupled to the first lens and a third lens coupled to at least one of the first lens and the second lens. The second lens, third lens and second portion are configured in series such that the lenses from a telescope that alters light rays in a second manner and forms a second image in the eye.

CROSS REFERENCES TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. application Ser. No.11/151,978, filed Jun. 14, 2005, entitled “INTRAOCULAR TELESCOPE,” acontinuation-in-part of U.S. application Ser. No. 10/455,788, filed Jun.6, 2003, entitled “TELEDIOPTIC LENS SYSTEM AND METHOD FOR USING THESAME,” U.S. application Ser. No. 10/600,371, filed Jun. 23, 2003,entitled “TELEDIOPTIC LENS SYSTEM AND METHOD FOR USING THE SAME,” whichis a continuation-in-part of U.S. application Ser. No. 10/873,495, filedJun. 23, 2004, and entitled “BIFOCAL INTRAOCULAR TELESCOPE FOR LOWVISION CORRECTION,” and is a continuation-in-part of U.S. applicationSer. No. 11/038,320, filed Jan. 17, 2005, entitled “BIFOCAL INTRAOCULARTELESCOPE FOR LOW VISION CORRECTION.” The entire contents of each ofthese applications are incorporated herein by reference.

BACKGROUND

Macular degeneration has become one of the leading causes of blindnessin adults. This disease affects the central retinal area known as themacula. The macula is responsible for acute vision—i.e., vision for suchthings as driving or reading a newspaper. Macular degeneration can leadto a gradual or sudden loss of vision to the level of 20/200 or less.Commonly, loss of vision only affects the central macular area of about0.25 to 4 square millimeters, and does not usually progress beyond thisarea, thereby leaving 95-99% of the retina unaffected. Thus, reading anddriving vision can be lost, while peripheral vision remains intact. Thiscondition is often referred to as low vision.

Most cases of macular degeneration are untreatable, although laserphotocoagulation has been successful in certain instances. Telescopicsystems that attach to eye glasses also have been used for many years toimprove vision in patients with macular degeneration. These systems,which work by increasing the retinal image of a given object, have notbeen very successful because they restrict the visual field to about11°, so that normal activity is not possible. They are also large andbulky. Attempts have been made to increase the visual field by puttingpart of the telescope within the eye. A Galilean telescope is useful forthis purpose and consists of a converging objective lens and a divergingocular lens, which together produce a telescopic effect.

U.S. Pat. Nos. 4,666,446 and 4,581,031, both to Koziol and Peyman, andboth of which are incorporated by reference herein, each discloseintraocular lenses which are implanted in the eye in place of thenatural lens to redirect the rays of light to minimize the adverseaffect on vision caused by the macular degeneration of the eye. Forexample, U.S. Pat. No. 4,666,446 discloses an intraocular lenscomprising a first portion including a diverging lens and a secondportion including a converging lens. The converging lens provides theeye with substantially the same focusing ability of the natural lensprior to implantation of the intraocular lens. Thus, the eye will havedecreased visual acuity due to the macular degeneration, but will alsohave unrestricted peripheral vision. The diverging lens, on the otherhand, when combined with a converging lens positioned outside of the eye(e.g., a spectacle lens), provides a magnified image with increasedvisual acuity but a restricted visual field. Therefore, this type ofintraocular lens creates a teledioptic lens system, which provides thepatient with the choice of unmagnified but peripherally unrestrictedvision or magnified but peripherally restricted vision.

U.S. Pat. No. 6,197,057 to Peyman and Koziol, the entire contents ofwhich are herein incorporated by reference, relates to a lens systemthat combines a high plus lens with a plus and minus intraocular lens(IOL), so that the lens system works in a manner similar to a Galileantelescope. Generally the high plus lens is outside the eye (i.e., inglasses or spectacles or in a contact lens) and the plus and minus lensis an IOL that replaces or works in conjunction with the natural lens ofthe patient (See FIGS. 1 and 2).

U.S. Pat. Nos. 4,074,368 and 6,596,026 B1, the entire contents of whichare herein incorporated by reference, both disclose telescopic implantsfor implantation within an eye. These implants are designed to replacethe natural lens in the eye with a telescope. They are rigid devicesrequiring a large incision in the eye to implant.

Although all of these systems are beneficial to patients with maculardegeneration, a continuing need exists for an intraocular implant thatcan correct for low vision in the eye.

SUMMARY

In one embodiment an intraocular lens is provided. The lens includes afirst lens having a first portion configured to alter light rays passingtherethrough in a first manner and a second portion. A second lens iscoupled to the first lens and a third lens is coupled to at least one ofthe first lens and the second lens. The second lens, the third lens andthe second portion are configured in series such that the lenses form atelescope.

In another embodiment, a method of altering vision in the eye isprovided. The method includes the steps of determining a first distancebetween a first lens and a second lens, determining a second distancebetween the second lens and a third lens, such that a configuration ofthe first lens, the second lens and third lens form a telescope in theeye, bonding the second lens to the third lens to fix the seconddistance, and coupling the second and third lens to the first lens.

Additional features and advantages of the present invention aredescribed in, and will be apparent from, the following DetailedDescription of the Invention and the figures.

BRIEF DESCRIPTION OF THE FIGURES

Referring to the drawings which form a part of this disclosure:

FIG. 1 is a cross-sectional view in side elevation of a human eye withan intraocular implant according to a first embodiment of the presentinvention;

FIG. 2 is an enlarged cross-sectional view in side elevation of thetelescope portion of the implant shown in FIG. 1 having a plus and aminus lens therein;

FIG. 3 is a top plan view of the intraocular implant shown in FIG. 1prior to implantation;

FIG. 4 is a side elevational view of the intraocular implant shown inFIG. 3;

FIG. 5 is an enlarged cross-sectional view in side elevation of amodified telescope portion of the present invention using diffractivelenses;

FIG. 6 is a top plan view of an intraocular implant similar to thatshown in FIGS. 3 and 4, but using U-shaped haptics;

FIG. 7 is a side elevational view of the intraocular implant shown inFIG. 6;

FIG. 8 is a cross-sectional view in side elevation of a human eye withan intraocular implant according to a second embodiment of the presentinvention with an artificial IOL substituted for the natural lens;

FIG. 9 is a cross-sectional view in side elevation of a human eye withan intraocular implant according to a third embodiment of the presentinvention used with the natural lens;

FIG. 10 is a cross-sectional view in side elevation of a human eye withan intraocular implant according to a fourth embodiment of the presentinvention;

FIG. 11 is a cross-sectional view in side elevation of a human eye withan intraocular implant according to a fifth embodiment of the presentinvention;

FIG. 12 is an enlarged cross-sectional view in side elevation of thetelescope portion of the intraocular implant of FIG. 11 having a plusand a minus lens therein;

FIG. 13 is an enlarged cross-sectional view in side elevation ofalternative telescope portion of the present invention for use with theembodiment of FIG. 11;

FIG. 14 is an enlarged cross-sectional view in side elevation of anotheralternative telescope portion for use with the embodiment of FIG. 11.

FIG. 15 is a cross-sectional view in side elevation of the embodiment ofFIG. 1 further including a contact lens on the cornea;

FIG. 16 is a cross-sectional view in side elevation of the embodiment ofFIG. 1 further including an external spectacle;

FIG. 17 is a top plan view of a bifocal contact lens;

FIG. 18 is a perspective view of an alternative telescope portion forproviding a teledioptic lens system;

FIG. 19 is an elevational side view in section of an external spectaclewith an opaque portion or member blocking light from passing through thecentral portion of the spectacle;

FIG. 20 is an elevational side view in section of the spectacles of FIG.19 with the opaque portion moved away from the central portion of thespectacle; and

FIG. 21 is an elevational side view of a telescopic lens systemaccording to another embodiment of the present invention;

FIG. 22 is a front view of a telescopic lens system according to anotherembodiment of the present invention;

FIG. 23 is a elevational side view in section of the lens system of FIG.22 taken along lines 23-23;

FIG. 24 is a side view in section of an eye with the natural lensremoved and the lens system of FIG. 23 implanted therein;

FIG. 25 is a front view of a telescopic lens system according to anotherembodiment of the present invention; and

FIG. 26 is a side view of the telescopic lens system of FIG. 25.

DETAILED DESCRIPTION

Referring to FIGS. 1-4, an eye 10 includes a cornea 12, iris 14, naturallens 16, zonular ligaments 18, ciliary sulcus 20, retina 22, and macula24. The natural lens 16, zonular ligaments 18, and ciliary sulcus 20divide the eye into an anterior chamber 26 and a posterior chamber 28.The macula 24 is located at the center of the retina 22, and isresponsible for providing acute vision, such as that necessary fordriving or reading. An intraocular telescopic lens implant 30 inaccordance with the invention is implanted in the anterior chamber 26 ofthe eye 10. The intraocular telescopic lens implant 30 has a telescopeportion 32 surrounded by a substantially transparent peripheral portion34.

The telescope portion 32 allows light to pass therethrough and has abi-convex converging, or plus, lens 36 and a bi-concave diverging, orminus, lens 38. The lenses 36, 38 are aligned along an optical axis 40to form a Galilean telescope. Preferably, the lenses are about 1-2 mm indiameter. The diverging lens 38 has a refractive index between −30 and−90 diopters, as measured in water. The converging lens 36 has arefractive index between +30 and +80 diopters, as measured in water. Thelenses 36, 38 are rigidly received in and fastened as necessary to thewall of a substantially cylindrical aperture 39 formed in the peripheralportion 34 of the implant 30, forming a cavity 42 therebetween. Thecavity 42 is preferably vacuum sealed. The use of a vacuum in cavity 42increases the refractive index, allowing for a smaller telescope. Thelenses 36, 38 can be forced-fit or adhered to the aperture 39 so they donot move relative thereto. The lenses 36, 38 are spaced approximately0.5 to 5 mm apart, depending on their particular optical properties, sothat the telescope portion is approximately 0.3 to 5 mm thick.

FIGS. 3 and 4 illustrate the intraocular telescopic implant 30 prior toimplantation. The substantially circular peripheral portion 34surrounding or substantially surrounding the telescope portion 32 ismade of a biocompatible, transparent, optical material. Peripheralportion 34 is preferably flexible, but can be rigid or partially rigidand partially flexible or any other suitable configuration. Theperipheral portion has a diameter of approximately 2 to 6.5 mm, and athickness of approximately 0.05 to 1 mm. The peripheral portion 34 mayhave refractive powers to correct for refractive errors in the eye, ormay have substantially no refractive powers. The peripheral portion 34may also have varying thickness and refractive power to correct for anyastigmatism in the eye. Further, the peripheral portion 34 can havemultiple focal adjustments—i.e., bifocal—to correct for and providemultiple refractive corrections. Arranged around the edge of theperipheral portion 34 are from two to four haptics 46 for fastening theimplant in the anterior chamber of the eye. Four haptics are shown inthe illustrated embodiment, but any number of haptics may be used. Withthe haptics, the diameter of the implant is approximately 10-14 mm.

To implant the intraocular telescopic implant in the eye, an incision ismade in the eye through the use of a microkeratome, laser, or othersuitable surgical device. The implant 30 is folded or rolled up, andinserted into the anterior portion of the eye through the incision. Theimplant 30 is allowed to unfold or unroll, and the haptics 46 extendinto the anterior chamber angle (i.e. the angle formed where the irisand the cornea meet) and fixate the implant into the anterior chamber 26of the eye 10. Since the implant 30 is foldable, the incision isrelatively small. This is beneficial because any incision to the eye cancause astigmatisms in the eye and require varying healing periods. Theimplant 30 may also be implanted into the posterior chamber, as shown inFIG. 10 and discussed below, or implanted into the capsular bag.

In use, the light rays that enter the eye from the central field ofvision are substantially parallel to the axis 40 of the telescopicimplant 30. Because they are parallel to the axis of the telescope, therays enter the telescope and are magnified and projected onto the retinato provide enhanced acute vision for the central field of vision. At thesame time, light rays from the peripheral field are unobstructed by thetransparent peripheral portion 34 of the lens implant so that thepatient retains unrestricted peripheral vision. Furthermore, because theperipheral portion of the implant is transparent, a doctor examining apatient's retina has an unobstructed view of the retina.

The lenses 36, 38 illustrated in FIGS. 1-2 are conventional bi-convexand bi-concave lenses. The conventional lenses are refractivelenses—i.e. they utilize refraction to modify how light propagatesthrough the lenses to change the focal point of the lenses. The lensesin the telescopic implant 30, however, may have any desirable shape orconfiguration.

FIG. 5 illustrates a telescope portion 32 which uses diffractive lenses42, 44. Diffractive lenses, such as Fresnel lenses, utilize diffractionto modify how light propagates through the lenses to change the focalpoint of the lenses. Diffractive lenses are advantageous because theyare very thin as compared to conventional refractive lenses. Othersuitable lenses include those made by ThinOptx, Inc. of Abingdon, Va.ThinOptx, Inc. manufactures intraocular lenses that are approximately100 microns thick with +/−25 diopters of correction. Further detailsregarding these lenses are found in U.S. Pat. Nos. 6,666,887 and6,096,077, which are hereby incorporated by reference in their entirety.When using technology such as this, the telescope portion can be about2-3 mm, preferably about 2 mm thick.

The implant 30 illustrated in FIG. 1 uses haptics 46 which affix theimplant into the anterior chamber angle. FIGS. 6 and 7 illustrate animplant 48 which uses alternative, substantially U-shaped haptics 50.Upon implantation, the U-shaped haptics 50 overlie the iris and can beclipped to the iris to provide added stability to the implant. Oneskilled in the art will recognize that although two preferred styles ofhaptics are specifically disclosed herein, there are a wide variety ofknown haptics and any suitable haptics, such as J-shaped haptics, can beused with the present invention.

Embodiment of FIG. 8

FIG. 8 shows a second embodiment of the present invention. In thisembodiment, the natural lens of the eye is replaced with an artificiallens 52. The artificial lens 52 has a central portion 54, a peripheralportion 56, and is fastened into the posterior chamber by haptics 58.The peripheral portion 56 of the lens 52 is a generally converging lens,much like the natural lens which it replaces. The central portion 54,however, is a diverging lens with a high negative refractive index. Ananterior implant 60 is located in the anterior chamber of the eye. Theanterior implant 60 has a transparent peripheral portion 62 and acentral portion 64. The central portion 64 is a lens with a highpositive refractive index. The anterior implant central portion 64 isaligned with the artificial lens central portion 54, forming a telescopefor enhancing low vision. The peripheral portion 62 has the samecharacteristics as peripheral portion 34 described above regarding thefirst embodiment of FIGS. 1-4.

Embodiment of FIG. 9

FIG. 9 illustrates a third embodiment of present invention. In thisembodiment, a first intraocular implant 66 is placed immediatelyadjacent the primary lens 68 and placed in the ciliary sulcus 69 of theposterior chamber by haptics 71. The illustrated primary lens 68 is anatural lens, but may also be an artificial intraocular lens. Thecentral portion 70 of the implant 66 is a lens with a high negativerefractive index and is surrounded by a peripheral portion 72, which hasthe same characteristics as portion 34 described above. A secondintraocular implant 74 is placed in the anterior chamber of the eye. Thesecond intraocular implant 74 has a central lens portion 76 with apositive refractive index and a peripheral portion 75 surrounding lensportion 76. Preferably, the central portions 70, 76 of the two implants66, 74 are aligned along the main optical axis (however, these lensescan be aligned in any suitable manner), forming a telescope as discussedabove regarding the embodiment of FIGS. 1-4.

Embodiment of FIG. 10

FIG. 10 shows a fourth embodiment of the present invention. In thisembodiment, the intraocular implant 78 has a telescope portion 80attached to a peripheral portion 82. The peripheral portion 82 is placeddirectly onto the primary lens 84 and is attached to the ciliary sulcus83 by haptics 85. The illustrated primary lens is a natural lens, butmay also be an artificial intraocular lens. The telescope portion 80preferably is formed from a flexible material, similar to portion 34.Additionally, telescope portion can be configured as tube 80 (FIGS.12-14) having similar characteristics as portion 34 or it can be formedas structure or telescope portion. 129 having struts or extensionmembers (FIG. 18).

As shown in FIG. 18, each strut 130, 132, 134, 136 is attached to theperiphery 138 of lens 38 (in any conventional manner, such as adhesiveor any other suitable means) and extends to the periphery 140 of lens 36and attaches thereto in the same or substantially similar manner. Thetelescope portion 129 can have any suitable number of struts. Forexample, the telescope portion can have as few as one strut or as manyas desirable. The struts are preferably formed from a material that canbe flexible, such as the material disclosed above or portion 34 or anyother suitable material. By forming the telescope portion 129 in thismanner, natural fluid from the eye can flow between the lenses of thetelescope portion. Additionally, the entire structure including thetelescope portion 129 and peripheral portion 82 can be folded wheninserted into the eye and unfolded after entry into the appropriatechamber. This flexibility allows the implant 78 to be inserted into asmaller incision in the surface of the eye, thus reducing possibledamage to the eye.

When implanted, the telescope portion preferably extends through theiris; however, it is noted that the telescope portion does notnecessarily need to extend through the iris and it can be situated inthe eye in any suitable manner. The peripheral portion 82 has the samecharacteristics as portion 34 described above.

Although preferable, it is not necessary for the telescope portion 80described in FIGS. 12-14 and telescope portion 129 described in FIG. 18to be used with peripheral portions. For example, the telescope portioncan be used with one peripheral portion, as disclosed in FIG. 10, twoperipheral portions as disclosed in FIG. 11 or no peripheral portions.When used with no peripheral portions, the telescopic portion can beaffixed inside the eye in any suitable manner, such as with haptics,adhesive or friction. Additionally, the telescopic portion can beaffixed to the natural lens, an artificial lens or any other suitablestructure (natural or artificial) inside the eye.

Embodiment of FIGS. 11 and 12

FIGS. 11 and 12 show a fifth embodiment of the present invention. Inthis embodiment, a first peripheral portion 86 is located in theposterior chamber of the eye, immediately adjacent the primary lens 89.A second peripheral portion 88 is located in the anterior chamber of theeye. A telescope portion 90 is formed by a converging lens 92, adiverging lens 94, and a tubular canister 96. The tubular canister 96 isrigidly received in circular apertures in the two peripheral portions86, 88 and connects the two peripheral portions 86, 88 through the iris.Preferably, the tubular canister and lenses 93 and 94 are flexible;however each can be rigid or any other suitable configuration.

The connection of the canister 96 at both the posterior and anteriorchambers of the eye improves the stability of the telescope. The cavity98 within tubular canister 96 may be vacuum sealed, or may contain airor water. To implant the telescope portion 90 of FIG. 12, the firstperipheral portion 86 is inserted into the eye and placed in the sulcus87 over the primary lens 89 by haptics 91. The illustrated primary lens89 is a natural lens, but may also be an intraocular lens. The telescopeportion 90 is then fastened to the first peripheral portion 86. Thesecond peripheral portion 88 is inserted into the anterior chamber andis fastened to the telescope portion 90. The peripheral portions 86, 88have the same characteristics as portion 34 described above.Furthermore, as described above, the telescope portion can be used withone peripheral portion, as disclosed in FIG. 10, two peripheral portionsas disclosed in FIG. 11 or no peripheral portions.

FIGS. 13 and 14 show two additional telescope portions which aresuitable for use in the embodiment of FIG. 11. The telescope portion 100shown in FIG. 13 is similar to the one in FIG. 12, but uses diffractiveor Fresnel lenses 102, 104 lenses instead of conventional refractiveconvex and concave lenses. In the telescope portion 106 shown in FIG.14, the diverging lens 108 and canister 110 are fastened to the firstperipheral portion 112 prior to implantation, and the connected piecesare implanted simultaneously. The second peripheral portion 114 andanterior lens 116 are then implanted, forming the telescope portion insitu. By assembling the telescope portion in this manner, the incisionis kept to the smallest possible size.

The implantation of the lenses described herein does not necessarilyneed to occur during one operating procedure and can occur over apredetermined period of time (e.g., seconds, minutes, days, weeks,months or years)

Additionally, the configuration shown in FIG. 18 is suitable for thisembodiment. For example, the telescope portion 129 can replace telescopeportion 82. As described above, telescope portion 129 can have flexiblestruts that allow fluid to flow therebetween. Preferably, as describedabove, the struts are flexible, so that the entire lens system,including the telescope portion can be inserted into the smallestpossible incision; however, the struts can be any suitable configuration(including rigid, if desired) and the telescope portion can have anynumber of struts desired. Any above description of telescope portion 129is application to this embodiment.

Furthermore, the telescope portions described herein can be used with anexisting IOL. For example, an existing IOLs that has high minus portionscan be supplemented with an IOL (e.g., a high plus lens) that isimplanted into the posterior or anterior chamber of the eye (or anyother suitable portion of the eye) forming a telescopic portion, asdescribed herein. Additionally, the supplemental IOL can be connected tothe existing lens using a strut(s) or a canister as described herein.The lenses described herein are merely exemplary, and the existing andsupplemental lenses can be any shape or configuration, as long as aportion of each can be combined to form a teledioptic or telescopic lenssystem. Examples of suitable existing IOLs are described in U.S. Pat.No. 4,666,446 to Koziol (discussed above), the entire contents of whichare incorporated herein by reference.

Embodiment of FIGS. 15-17, 19 and 20

Although the invention so far has been described without the use of asupplemental lens outside the eye, it should be understood that theimplants can also be used in conjunction with a supplemental lenslocated outside the eye. FIGS. 15 and 16 illustrate this. In FIG. 15, asupplemental plus contact lens 118 is placed on the cornea 12. In FIG.16, a supplemental spectacle with two plus lenses 120 is placed in thevisual path. In both cases, the lenses 118, 120 have a positiverefractive index. The use of supplemental lenses outside the eye allowsfor smaller implants inside the eye. Further, the use of supplementallenses allows the construction and operation of the implants to betailored to particular patients' desires. For instance, many individualshave a preferable reading distance (typically between 20 and 50 cm awayfrom the eye) and a supplemental lens allows the focal distance to betailored to coincide with an individual's preferred reading distance.The supplemental lenses themselves can be bifocal. FIG. 17 illustrates acontact lens 122. The central 2-7 mm portion 124 of the contact lens 122provides refractive correction for near vision.

Preferably, the peripheral portion 126 (of either the contact lens orthe spectacles) provides refractive correction for far vision. Theperipheral portion 126 can have any refractive properties desired. Forexample, the peripheral portion can be used to correct myopia,hyperopia, astigmatism, presybyopia, or any other vision error, or theperipheral portion of the lens can have no refractive properties, thusallowing a patient with acceptable peripheral vision to see with nocorrection (other than the telescopic central correction).

As shown in FIGS. 19 and 20, the spectacles 120 can have a removableopaque portion 130 that can be positioned over the central portion 132of each lens. Preferably, the opaque portion 130 is substantiallycircular and is substantially the same size and shape as the centralportion 132 of each lens.

As shown specifically, in FIG. 19, the opaque portion 130 blocks out orcovers the central portion 132, thus eliminating or substantiallyeliminating light from passing through the central portion of thespectacle lenses and through the implanted lens(es) adapted to form atelescopic system. Substantially all light that enters the eye passesthrough the peripheral portion 134 of the spectacle lenses 120 andeither focuses directly onto the peripheral portion of the retina orpasses through the peripheral portion of an implanted lens and then ontoa peripheral portion of the retina.

Opaque portion or member 130 is preferably connected to the frame of thespectacle by arm member 136. The arm member is preferably hinged to thespectacles in any suitable fashion. However, it is noted that the opaqueportion can be coupled to any portion of the spectacles desired. Forexample, the opaque portion can be coupled to the lens, the centralportion of the frame (i.e., at or near the nose portion), the peripheralportion of the frame or in any other suitable manner. Additionally, asdescribed herein the opaque portion does not necessarily need to becoupled to the spectacles using a hinged arm and can be connected (ornot) in any manner desired.

When the patient desires to focus at near objects (e.g., reading,driving, etc.) the opaque portion 130 can be flipped out of the way(FIG. 20) of the central portion 132 or removed in any other suitablemanner. This allows light to pass through the central portion 132 of thespectacle lens(es) and pass through the telescopic portion of the lenssystem, thus enabling the patient to focus on a near object.

Additionally, if desired an opaque portion can be positioned to coverthe peripheral portion 134 to eliminate substantially all light fromentering the peripheral portion 134 of the spectacles 120. Spectacles120 can have two concentric opaque portions: 1) the central opaqueportion; and 2) a concentric substantially ring-shaped opaque portionthat can be flipped up or down, depending on the type of vision desiredby the patient. For example, if the patient desired near vision, thecentral opaque portion can be flipped up or moved away from the centralportion of the spectacles, and the substantially ring-shaped portioncould be flipped down to cover the peripheral area of the spectaclelens(es). If the patient desired to see using the peripheral portion ofthe spectacle lens(es) the central opaque portion could be flipped downto cover the central portion and the substantially ring-shaped portioncould be flipped up or moved away from the peripheral portion of thespectacle lens(es).

It is noted that each opaque portion can be used alone or in combinationwith any other opaque portion, and that the opaque portions can beapplied or used to cover the spectacle lens(es) in any manner desired.For example, the opaque portions can be attached to the spectacles usinga lever arm 136 as shown in FIGS. 19 and 20, the opaque portion can beattached using adhesive, static, the opaque portion can be applied usingany type of marking device, or the opaque portions can be any device ormethod that would obscure a portion or all of any type of lens,spectacle, contact or any other type.

Embodiments of FIGS. 21-24

FIGS. 21-24 illustrate additional embodiments of the present invention,wherein the telescopic intraocular lens system 150 includes at leastthree lenses, a first lens 152, a second lens 154 and a third lens 156.As with the above described systems, the present lens system preferableincludes each of the lenses positioned substantially in series with eachof the other lenses along the main optical axis of the eye.

Preferably first lens 152 is a plus lens (i.e., a biconvex asphere) andis positioned, relative the second and third lenses, closest to thecornea or the front of the eye. The first lens is preferable formed fromPMMA; but can be formed from any suitable material(s). First lens 152can also have any configuration desired and/or change or correct therefractive properties of the eye in any manner desired, that is, firstlens 152 can be biconvex, biconcave, toric or any suitable combinationthereof. First lens 152 preferably has a diameter between about 1.0 mmand about 1.5 mm, but can have any suitable diameter.

Second lens 154 is preferably a multifocal or bifocal lens. That is thesecond lens preferably has two different zones for focusing light;however, it is noted that the second lens can have any number of zonesof portions capable of focusing, including one or more than two. Secondlens 154 is preferably positioned, relative to the first and thirdlenses closest to the natural lens of the eye, if present or closest tothe rear of the eye. Peripheral portion 158 of the lens 154 is agenerally a converging lens (i.e., a biconvex asphere). Peripheralportion 158 preferably has a diameter about 6.0 mm; but can have anysuitable diameter. The central portion 160, is a diverging lens with ahigh negative refractive index i.e. a biconcave lens) and has a diameterof about 1.0 mm, but can have any suitable diameter. However, it isnoted that the both the central portion and the peripheral portion canbe any suitable configuration desired and/or be adapted to change orcorrect the refractive properties of the eye in any manner desired orhave no corrective properties, thus allowing light to merely passtherethrough. Second lens is preferably formed from PHMA (HEMA), but canbe formed from any suitable material(s). Additionally, second lens 154is preferably positioned in series or substantially in series with lens152 and substantially along the main optical axis of the eye.

As shown in FIG. 21, third lens 156 is preferably a minus lens (i.e.,biconcave) and is preferably positioned substantially between the firstand second lenses, along the main optical axis. As with the first andsecond lenses, third lens can be any suitable configuration desiredand/or be adapted to change or correct the refractive properties of theeye in any manner desired. Additionally, as with the first lens, thirdlens 156 is preferably formed from PMMA, but can be formed from anyother suitable material(s). Third lens 156 preferably has a diameterbetween about 1.0 mm and about 1.5 mm, but can have any suitablediameter.

As shown in FIGS. 22-24, first lens 152 can be coupled to second lens154 using two struts or coupling members 162 and 164. Preferably, struts162 and 164 have a first portion 166 and 168, respectively, that eachextends radially outwardly from the periphery 170 of lens 152. At aboutthe periphery of the second lens 156 two protrusions or extensions 172and 173 extend. The protrusions are about 180° offset from each other.Protrusion 172 has two openings 172 a and 172 b and protrusion 173 hastwo openings 173 a and 173 that each extend through a respectiveprotrusion. Second portions 174 and 176 of struts 162 and 164,respectively, extend substantially perpendicularly or at angle slightlygreater than 90° to the first portion of each strut (substantiallyparallel to the main optical axis) and toward a respective protrusion onthe second lens, coupling to the second lens at a substantiallyperpendicular angle. Each strut extends through a respective opening inthe protrusions, allowing the struts to couple thereto. It is noted thatthe struts can couple the first lens to the second lens in any mannerdesired and do not necessarily need to be configured as described hereinand/or do not need to couple to the lens as described herein.

Additionally, the first lens does not necessarily need to couple to thesecond lens and can couple to the third lens if desired. Furthermore, itis not necessary for the first lens to couple to the second lens usingtwo struts and the first lens can couple to the second (and/or third)lens using as many or as few (one) struts as desired.

Third lens 156 preferably couples to second lens 154 using two struts180 and 182. Structurally, struts 180 and 182 are substantially similarto struts 162 and 164. That is, struts 180 and 182 preferably each havea first portion 184 and 186, respectively, and a second portion 188 and190, respectively, Each first portion extends radially outwardly fromthe periphery 191 of the third lens and each second portion 188 and 190extend from a respective first portion substantially at a 90° degreeangle or substantially parallel to the main optical axis and couples tothe second lens through a opening or hole therein. As shown in FIG. 22,struts 180 and 182 extend from the third lens periphery slightlyradially offset from struts 162 and 164. Thus, struts 180 and 182 cancouple to the second lens at a different peripheral portion than struts162 and 164.

As with struts 162 and 164 the struts can couple the third lens to thesecond lens in any manner desired and do not necessarily need to beconfigured as described herein and/or do not need to couple to the lensas described herein. Additionally, the third lens does not necessarilyneed to couple to the second lens and can couple to the first lens ifdesired. Furthermore, it is not necessary for the third lens to coupleto the second lens using two struts and the third lens can couple to thesecond (and/or first) lens using as many or as few (one) struts asdesired.

Extending from the periphery of second lens 154 are haptics 192.Although two J-shaped haptics are shown, the present device can have naynumber of haptics and the haptics 192 can be any suitable configurationdesired. Additionally, any or all of lenses 152, 154 and 156 can haveany number of haptics extending thereof, or can be positioned and/orcoupled inside of the eye in any manner desired.

As shown in FIG. 24, intraocular lens system 150 is positioned in theposterior chamber of the eye and replaces the natural lens of the eye.Preferably haptics 192 couple the lens system to the eye by piercing theciliary sulcus 20 of the eye. However, as stated above the lens systemcan be positioned in the eye in any manner desired. Each of the lenses152, 154 and 156 is preferably positioned substantially centered aroundthe main optical axis of the eye in series with each other lens, forminga telescopic or teledioptic lens system.

This system type of system allows light traveling through the peripheralportion of the eye to be focused on the retina by the peripheral area ofthe of the second lens and/or the natural and/or an artificial lens andlight traveling through the central portion of the cornea to bemagnified by the series of lenses and/or the natural and/or anartificial lens, thus forming a bifocal or multifocal lens system. Morespecifically, this type of lens system allows the patient to view farobjects and near objects without the aid of external lenses. However, itis noted that this type of lens system is suitable for use with externallenses (e.g., glasses or contacts), if desired.

Additionally it is noted that the lens system described herein can beused to supplement or to replace the natural lens of the eye.Additionally, the system described herein is not limited to bepositioned as shown herein, that is, all lenses positioned in theposterior chamber. Each lens can be positioned in either the anterior orposterior chamber of the eye, or positioned in the pupil spanning boththe anterior and the posterior chambers. For example, (1) first lens 152can be positioned in the anterior chamber and second lens 154 and thirdlens 156 can be positioned in the posterior chamber; (2) the first andthird lenses can be positioned in the anterior chamber and the secondlens can be positioned in the posterior chamber; or (3) the first,second and third lenses can each be positioned in the anterior chamber.

In examples (1) and (2) of the above paragraph, it may be beneficial tocouple the first lens directly to the third lens and/or the third lensdirectly to the second lens. Furthermore, the coupling member or strutsin such a case can be configured such that they can pass though thepupil and not the iris, see for example, FIG. 18. However, it is notedthat the lenses can couple to each other in any manner desired(including passing through the iris) and also that if desired the lensesdo not need to be coupled together but can merely be positioned withinthe eye at the appropriate position relative to each other lens.

Embodiment of FIGS. 25-27

FIGS. 25-27 illustrate another embodiment of the present invention,wherein a lens system 200 includes a first lens 202, a second lens 204and a third lens 206; however, it is noted that this system is notlimited to a specific number of lenses and it can have any suitablenumber of plus, minus, toric or other lenses. For example, lenses 204and 206 can each be eliminated or divided into additional plus and/orminus lenses to create the desired refractive properties. Each lensprefereably has a refractive index of about 1.48, but can have anysuitable refractive index.

First lens 202 is similar to lens 154 in that lens 202 is a multifocalor bifocal lens and can replace the natural and/or existing artificiallens or it can be used in conjunction with the natural or artificiallens(es) (i.e., a piggyback lens). That is, lens 202 can piggyback ontoexisting intraocular lenses already in a patient's eye (for example, apolymer lens), the natural lens or any new lens positioned in the eye.When used as a piggyback lens, lens 202 can be positioned on theposterior surface, anterior surface or any other portion of the existingnatural or artificial lens desired. Using lens 202 as a piggyback lenswill allow the existing lens to be completely emetrope or substantiallycompletely emetrope.

Lens 202 preferably has a peripheral portion 208 and a central portion210, such that lens 202 has two different zones for focusing light;however, it is noted that lens 202 can have any number of zones ofportions capable of focusing, including one or more than two. Lens 202is preferably positioned, relative to lenses 204 and 206, closest to thenatural lens of the eye, if present or closest to the rear of the eye ifthe natural lens has been removed. However, lenses 204, 206 and 202 canbe positioned in any order and in any suitable portion of the eye.Peripheral portion 208 of lens 202 is a generally a converging lens(i.e., a biconvex asphere). Peripheral portion 208 preferably has adiameter about 6.0 mm; but can have any suitable diameter.

The central portion 210, is a preferably a diverging lens with a highnegative refractive index (i.e. a biconcave lens or any combination oflenses having a power of about −790 diopters) and has a diameter ofabout 1.0 mm to about 1.5 mm, but can have any suitable diameter and/orpower. Additionally, it is noted that both the central portion and theperipheral portion can be any suitable configuration desired and/or beadapted to change or correct the refractive properties of the eye in anymanner desired or have no corrective properties, thus allowing light tomerely pass therethrough. Lens 202 is preferably formed from PHMA(HEMA), but can be formed from any suitable material(s). Preferably,lens 202 is formed from material that is flexible so that it can befolded for insertion into the eye; however foldablility is notnecessary. Additionally, lens 202 is preferably positioned in series orsubstantially in series with lenses 204 and 206 and substantially alongthe main optical axis of the eye. If desired each of the hereindescribed lenses can be formed of any suitable flexible material toallow them to be bent or folded to facilitate insertion into the eye.

Lens 204 is prefereably a diverging lens with a high negative refractiveindex (i.e. a biconcave lens or any combination of lenses having a powerof about −790 diopters) and has a diameter of about 1.0 mm to about 1.5mm, but can have any suitable diameter and/or power. However, it isnoted that lens 204 can be any suitable configuration desired and/or beadapted to change or correct the refractive properties of the eye in anymanner desired or have no corrective properties, thus allowing light tomerely pass therethrough. Lens 204 is preferably formed from PHMA(HEMA), but can be formed from any suitable material(s).

Lens 206 is prefereably a preferably a converging lens (i.e., a biconvexasphere or any combination of lenses having a power of about 250diopters) and has a diameter of about 1.0 mm to about 1.5 mm, but canhave any suitable diameter and/or power. However, it is noted that lens206 can be any suitable configuration desired and/or be adapted tochange or correct the refractive properties of the eye in any mannerdesired or have no corrective properties, thus allowing light to merelypass therethrough. Lens 204 is preferably formed from PHMA (HEMA), butcan be formed from any suitable material(s).

As with the embodiments described above, this lens system 200 isconfigured to form or project multiple images in the eye. For example,portion 208 of lens 202 is configured to focus light from the peripheralfield of vision on the retina to form a first image in the eye, andlenses 204 and 206 and portion 210 are configured to focus light fromthe central visual field on the retina to form a second image in theeye.

Prefereably, portion 208 has about the same refractive properties as anormal or natural lens and operates by itself or in conjunction with thenatural lens to focus the peripheral light passing therethrough onto theretina to allow a patient to view far objects; however, it is noted thatportion 208 can operate in any suitable manner, including focusing onclose objects.

While focusing on far objects, preferably the image produced by lenses204 and 206 and portion 210 is diverged and does not produce a suitableimage on the retina. However, it is noted that if desired, the imageproduced by lens 204 and lens 206 and portion 210 and the image orimages produced by lens 208 can by projected onto the retina atsubstantially the same time to form a substantially continuous image orany other suitable combination of images.

Similarly, when focusing on near objects through lenses 204 and 206 andportion 210, the imaged produced by lens 208 is converged such that theimage is not suitably projected onto the retina, and the image producedby lens 204 and 206 and portion 210 is an enlarged or magnified imagethat is projected onto the retina. However, as described above, anysuitable combination of images can be produced.

Lens 204 is prefereably connected or coupled to lens 202 using struts212 and 214. Preferably, struts 212 and 214 each extends radiallyoutwardly from the periphery 216 of lens 204 and curve toward lens 202.At about the periphery of the second lens 202 two protrusions orextensions 218 and 220 extend. The protrusions are about 180° offsetfrom each other. Protrusion 218 has an opening 218 a, protrusion 220 hasan opening 220 a that each extend through a respective protrusion.Struts 212 and 214 have a respective portion 222 and 224 that extend atany suitable angle from the first portion of each strut (preferablysubstantially parallel to the main optical axis) and toward a respectiveprotrusion on lens 202, coupling lens 204 to lens 202. Each strutextends through a respective opening in the protrusions, allowing thestruts to couple thereto. Plugs or connectors 223 and 225 are insertedinto the opposite side of opening 218 a and 220 a, respectively andfacilitate the coupling of struts 212 and 214 to lens 202. It is notedthat the struts can couple the first lens to the second lens in anymanner desired. For example, the strut can be adhered, bonded,frictional fit or coupled in any other suitable manner. Additionally,the struts do not necessarily need to be configured as described.

Lens 206 is prefereably connected or coupled to lens 204 using struts226 and 228. Preferably, struts 226 and 228 each extends radiallyoutwardly from the periphery 230 of lens 206. Struts 212 and 214 eachhave a respective opening 232 and 234 that are configured to receive aprotrusion or portion 236 and 238 or struts 226 and 228, respectively.Portions 236 and 238 extend substantially parallel to the main opticalaxis and couple lens 206 to lens 204. It is noted that the struts cancouple lens 206 to lens 208 in any manner desired. For example, thestrut can be adhered, bonded, frictional fit or coupled in any othersuitable manner. Additionally, the struts do not necessarily need to beconfigured as described. For example, each lens can couple using anynumber of struts desired or by any other connection desired and thestruts themselves can have any suitable configuration.

Additionally, it is noted that lenses 202, 204 and 206 do not each needto be coupled together as described herein and any one of each lens canbe coupled to any other lens or coupled to no lenses.

As shown in FIG. 27, external lens 240 is preferably used in conjunctionwith lens system 200, although the lens system described above canoperate without the use of an external spectacle or lens. External lens240 can be any suitable external lens, such as spectacles, glasses,contact lenses or any other suitable lens that is easily positioned infront of or proximal to the eye. Preferably lens 240 is a converginglens with a power of about 20 diopters, but lens can have any suitablepower or no power. Additionally, lens 240 can be partially or fullyimplanted into the cornea or other portion of the eye is desired. Forexample, intrastromal corneal inlays and subepithelial corneal onlaysare both suitable for use in conjunction with lenses 202, 204 and 206.

Lens 240 is preferably a plus lens or converging lens that is configuredto facilitate focusing of light through lens 204 and lens 206 andportion 210. In other words, when lens 240 is positioned adjacent or infront of the eye, light is focused through lens 204 and lens 206 andportion 210, thus forming an image on the retina that is magnified about3.5×; however, it is noted that any suitable combination of lenses canbe used to great any magnification desired. When lens 240 is removed,light passes through the cornea and is focused on the retina byperipheral portion 208, as described above.

In another embodiment, lens 204 and lens 206 and portion 210 can bepolarized to permit light oriented in a first direction to passtherethrough and portion 208 can be polarized to permit light orientedin a second to pass therethrough. Prefereably, the polarized firstdirection is 90° offset from the polarized second direction.

Additionally, lens 240 can have a first portion 242 and a second portion244 that are similarly polarized. That is, for example, second portion244 can be polarized to permit light having substantially the sameorientation as lens 204 and lens 206 and portion 210 and first portion242 can be polarized to permit light having substantially the sameorientation as portion 208. Therefore, when the patient views an objectthrough the first portion 242 the object is projected onto the retinathrough portion 208 and substantially no light passes through lens 204and lens 206 and portion 210. Conversely, when an object is viewedthrough second portion 244 the object is projected onto the retinathrough lens 204 and lens 206 and portion 210 and substantially no lightpasses through portion 208. It is noted that is not necessary for lens240 to merely have two portions. Lens 240 can have any number ofportions desired, including one and more than two. For example, if lens240 has only one portion, lens 204 and lens 206 and portion 210 can bepolarized to substantially match the polarization of lens 240. In thisinstance, when the lens is adjacent the eye the light would be polarizedand pass through lens 204 and lens 206 and portion 210, and when thelens 240 is removed or not adjacent the eye the light would pass throughportion 208. Portion 208 can be the polarized portion (i.e., 204 andlens 206 and portion 210 would not be polarized) in this example, ifdesired.

Furthermore, lens 202 preferably has haptics 246 and 248 extendingtherefrom to couple the lens system 200 in the eye. Haptics 246 and 248are merely exemplary and lens system 200 can be positioned in the eye inany suitable manner.

Preferably, lens 204 and 206 are coupled together prior to insertioninto the eye and/or prior to examination a patient. By fixing theselenses together, it is possible to determine the optimal distance toproduce a telescopic effect. Additionally, lens 202 can be coupledsubstantially at the same time to accurately fix the optimal distance.However, it is noted that the lenses 202, 204 and 206 can be coupledtogether at anytime before or after examination of the patient.

It is noted that any of the lenses described herein can have any desiredconfiguration and/or can be configured to correct for any desiredoptical aberration.

EXAMPLES

The following tables show specific examples for the dimensions anddesign of an intraocular lens system according to the present invention.These examples were evaluated on an axis and a small field angle in 555nm light and conditions within the eye (35° C. and surrounded by mediawith index of refraction of 1.336). The in situ power of the peripheralpart of the primary IOL (or for example, lens 154) is 20 D. Theapproximate angular magnification is 3× at a distance of 50 cm comparedto an equivalent eye with a 20 D IOL. 3X/20 D Intraocular Telescope - 50cm reading distance Thick- Surface Radius(mm) Conic K Material Diam(mm)ness(mm) 152, 206 1.5 −1.659937 PMMA 1.5 0.6 Anterior 152, 206 −0.75−1.659937 1.336 1.5 2.0 Posterior 156, 204 −0.707385 −5.180637 PMMA 1.00.3 Anterior 156, 204 0.707385 −5.180637 1.336 1.0 0.5 Posterior 154,−0.530481 0 PHMA 1.0 0.3 202 cent S0 154, 202 0.530481 0 1.336 1.0 centS1 154, 202 12.215 0 PHMA 6.0 periph S0 154, 202 −12.215 0 1.336 6.0periph S1Note:K = −e²

3X/20 D Intraocular Telescope (0.5 mm space between third lens andsecond-slightly larger angular magnification) 50 cm reading distanceThick- Surface Radius(mm) Conic K Material Diam(mm) ness(mm) 152, 2061.5 −1.638534 PMMA 1.5 0.6 Anterior 152, 206 −0.75 −1.638534 1.336 1.52.0 Posterior 156, 204 −0.604687 −3.024514 PMMA 1.0 0.3 Anterior 156,204 0.604687 −3.024514 1.336 1.0 1.0 Posterior 154, 202 −0.596196 0 PHMA1.0 0.3 cent S0 154,202 0.596196 0 1.336 1.0 cent S1 154, 202 12.215 0PHMA 6.0 periph S0 154, 202 −12.215 0 1.336 6.0 periph S1Note:K = −e²

The following table illustrates an example with a 25 cm readingdistance. 3X/20 D Intraocular Telescope (0.5 mm space between the thirdlens and the second lens - slightly larger angular magnification) 25 cmreading distance Thick- Surface Radius(mm) Conic K Material Diam(mm)ness(mm) 152, 206 1.5 −1.635769 PMMA 1.5 0.6 Anterior 152, 206 −0.75−1.635769 1.336 1.5 2.0 Posterior 156, 204 −0.619793 −3.112455 PMMA 1.00.3 Anterior 156, 204 0.619793 −3.112455 1.336 1.0 1.0 Posterior 154,202 −0.601335 0 PHMA 1.0 0.3 cent S0 154, 202 0.601335 0 1.336 1.0 centS1 154, 202 12.215 0 PHMA 6.0 periph S0 154 periph −12.215 0 1.336 6.0S1

These examples are not meant to limit the scope of the invention and aremerely to facilitate understanding of the invention. The intraoculartelescope embodiments described herein can have any suitable dimensions,sizes or configurations suitable for correction and/or changing therefractive properties of the eye.

It should be understood that various changes and modifications to thepresently preferred embodiments described herein will be apparent tothose skilled in the art. Such changes and modifications can be madewithout departing from the spirit and scope of the present invention andwithout diminishing its intended advantages. It is therefore intendedthat such changes and modifications be covered by the appended claims.

1. An intraocular lens, comprising: a first lens having a first portionconfigured to alter light rays passing therethrough in a first mannerand form a first image in an eye and a second portion adjacent saidfirst portion; a second lens coupled to said first lens; and a thirdlens coupled to at least one of said first lens and said second lens;said second lens, said third lens and said second portion configured inseries such that they from a telescope that alters light rays in asecond manner and form a second image in the eye.
 2. An intraocular lensaccording to claim 1, wherein said first portion is configured to formmultiple images in the eye.
 3. An intraocular lens according to claim 1,wherein said second lens, said third portion and said second portionconfigured to operate in conjunction with a lens positioned externallyof the eye.
 4. An intraocular lens according to claim 1, wherein saidsecond portion is positioned substantially in the center of said firstportion.
 5. An intraocular lens according to claim 4, wherein saidsecond portion is a negative lens.
 6. An intraocular lens according toclaim 1, wherein said second lens is a negative lens.
 7. An intraocularlens according to claim 1, wherein said third lens is a positive lens.8. An intraocular lens according to claim 1, wherein at least one strutcouples said third lens to said second lens, so that aqueous fluid canpass between said third lens and said second lens.
 9. An intraocularlens according to claim 8, wherein said third lens and second lenscouple to said first lens using a barb.
 10. An intraocular lensaccording to claim 8, wherein said at least one strut includes a firstand a second strut, said first strut being 180 degrees opposed from saidsecond strut.
 11. An intraocular lens according to claim 1, wherein saidsecond lens is bonded to said third lens.
 12. An intraocular lensaccording to claim 1, wherein said second lens, said third lens and saidsecond portion are polarized such that they filter light orientated in afirst direction and said first portion is polarized such that it filterslight oriented in a second direction.
 13. An intraocular lens accordingto claim 12, wherein said first orientation is 90° offset from saidsecond direction.
 14. An intraocular lens according to claim 12, whereinsaid second lens, said third lens and said second portion and said firstportion are configured to operate with an external lens, such that whensaid external lens is positioned proximal to the eye, said second imageis formed in the eye and when said external lens is not proximal to theeye, said first image is formed in the eye.
 15. An intraocular lensaccording to claim 12, wherein said second lens, said third lens andsaid second portion and said first portion are configured to operatewith an external lens, such that when an object is viewed through afirst portion of said external lens, said first image is formed in theeye and when said object or another object is viewed through a secondportion of said external lens said second image is formed in the eye.16. An intraocular lens according to claim 15, wherein said firstportion of said external lens is polarized such that it filters lightorientated in a first direction and said first portion of said externallens is polarized such that it filters light oriented in a seconddirection, said first orientation being 90° offset from said seconddirection.
 17. An intraocular lens according to claim 1, wherein saidsecond lens, said third Lens and said second portion and said firstportion are configured to operate with an a lens selected from the groupconsisting of: spectacles, a contact lens, an intrastromal cornealinlay, and a subepithelial corneal onlay.
 18. A method of alteringvision in the eye, comprising the steps of providing a first lens, saidfirst lens having a first portion configured to alter light rays passingtherethrough in a first manner to form a first image in the eye and asecond portion adjacent said first portion, determining a first distancebetween the second portion and a second lens; determining a seconddistance between the second lens and a third lens, such that aconfiguration of the first lens, the second lens and third lens form atelescope in the eye configured to alter said light rays in a secondmanner and form a second image in the eye; bonding the second lens tothe third lens to fix the second distance; and coupling the second andthird lens to the first lens to fix the first distance.
 19. A methodaccording to claim 18, wherein said first portion is configured to alterlight rays to correct one of the following: hyperopia, myopia,astigmatism, persbyopia.
 20. A method according to claim 18, whereinsaid second portion is positioned substantially in the center of saidfirst portion.
 21. A method according to claim 18, wherein said secondportion is a negative lens.
 22. A method according to claim 18, whereinsaid second lens is a negative lens.
 23. A method according to claim 22,wherein said third lens is a positive lens.
 24. A method according toclaim 23, wherein the bonding step includes bonding said third lens tosaid second lens with at least one strut, such that aqueous fluid canpass between lenses.
 25. A method according to claim 24, wherein thecoupling step includes coupling said third lens and second lens to saidfirst lens using a barb.
 26. A method according to claim 24, wherein thebonding step includes bonding said third lens to said second lens with afirst strut and a second strut, said first and second struts being 180degrees opposed.
 27. A method lens according to claim 18, wherein saidfirst portion is configured to form multiple images in the eye.